Evolving understanding of the classification of fibromyalgia following surgery

Abstract

Fibromyalgia (FM) is a condition characterized by chronic widespread pain, psychological disturbances, and physical impairments with controversy surrounding the underlying pathophysiology and no diagnostic confirmatory test. There are many shared features between FM and CRPS, and we theorize that some sub-set of clinically diagnosed FM is the result of a diffuse form of CRPS. Our objective in this case series is to outline two post-surgical patients with eventual diagnosis of FM. Case Report Case 1: African-American male veteran with medical history significant for repeat incision and drainage of sebaceous cysts in his bilateral axilla. Patient noted throbbing bilateral axillary pain for up to 90 days after each incision and drainage. After his surgeries were completed in the late 1980s he continued to demonstrate increasingly chronic and more widespread pain, throbbing in nature, no alleviating factors, and exacerbated by movement and cold weather. Diagnosed with fibromyalgia by the American College of Rheumatology criteria in 2001. Case 2: Female veteran with a medical history significant for uterine cancer and cervical cancer. Initial cervical cancer surgery in 1991. Hysterectomy in 1999. Post hysterectomy, she noted diffuse body pain with failed pharmacologic regimens including opiates, herbal therapies, trigger point injections, and steroid injections. She was formally diagnosed by the American College of Rheumatology criteria with fibromyalgia in 1999. This case series presents two patients with no prior history of chronic pain or no known psychiatric history who developed post surgically fibromyalgia. There is a very small body of evidence correlating fibromyalgia with a post surgical patient with most literature focusing on CRPS in the post surgical patient or FM/CRPS in the post-traumatic patient. Further cohort studies and meta-analysis are needed to demonstrate variables that may predispose surgical patients to FM.